Insurance Complaint Form
: 26/06/2022

Personal Information

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Complaint Information

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Complaint Details

You have TWO options for entering the details:

  1. A textbox to be filled by typing.
  2. Voice recorder button to record details in no more than two minutes. (Voice Recorder is optional)
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# Documents

Agreement

I, the undersigned, admit that all information contained in this application and the documentation provided is true and correct and endurance of all the legal consequences, and that the Authority has the right to use all the information related to the complaint for study, research and development.